Health initiatives aimed at Indigenous populations in Mexico: a critical perspective.

backgroundGovernmental action in Mexico has sought to understand and address the health situation of Indigenous Peoples (IPs) primarily through an intercultural perspective. However, intercultural approaches focused mainly on cultural aspects may obscure the historical and structural origins of health inequalities. Since the 1980s and during the early years of the new millennium, a series of political and institutional processes shaped a context that was central to incorporating IPs into the national health agenda.

objectiveThe aim of this article is to conduct a critical analysis of health initiatives targeting IPs developed within this context (2000-2012). METHODOLOGY: We carried out a qualitative critical analysis on the basis of a multi-source documentary review to analyse four specific initiatives, selected because they sought to include the participation of Indigenous leaders and explicitly incorporated an intercultural perspective.

resultsThe government-led initiatives APV, PROSANI and EEM reproduced cultural essentialisms through a functional and relational intercultural approach and did not contribute to improving the situation of traditional medicine actors, such as midwives. In contrast the CAMIA initiatives have a community-based origin and, for more than two decades, have been a fundamental space for the health and rights of Indigenous women. DISCUSSION AND

conclusionsThe incorporation of interculturality in most initiatives appears to respond to a State discourse strategy embedded in narratives of what is considered "politically correct," aimed at legitimizing programs and actions. The perspective from which health initiatives targeting Indigenous Peoples are designed, developed and implemented, as well as the actors involved in these processes and the degree of power and control exercised by both governmental actors and potential users/beneficiaries, determine their transformative potential. Initiatives built upon critical interculturality and with strong community foundations have had a significant impact on health and on other areas of Indigenous women's lives. There is an urgent need to rethink healthcare approaches for Indigenous Peoples in Mexico by adopting more critical intercultural frameworks that enable Indigenous self-determination and decolonial health perspectives.